Objective To evaluate the predictive ability and clinical application value of artificial intelligence (AI) systems in the benign and malignant differentiation and pathological type of pulmonary nodules, and to summarize clinical application experience. Methods A retrospective analysis was conducted on the clinical data of patients with pulmonary nodules admitted to the Department of Thoracic Surgery, Second Hospital of Lanzhou University, from February 2016 to February 2025. Firstly, pulmonary nodules were divided into benign and non-benign groups, and the discriminative abilities of AI systems and clinicians were compared. Subsequently, lung nodules reported as precursor glandular lesions (PGL), microinvasive adenocarcinoma (MIA), and invasive adenocarcinoma (IAC) in postoperative pathological results were analyzed, comparing the efficacy of AI systems and clinicians in predicting the pathological type of pulmonary nodules. Results In the analysis of benign/non-benign pulmonary nodules, clinical data from a total of 638 patients with pulmonary nodules were included, of which there were 257 males (10 patients and 1 patient of double and triple primary lesions, respectively) and 381 females (18 patients and 1 patient of double and triple primary lesions, respectively), with a median age of 55.0 (47.0, 61.0) years. Different lesions in the same patient were analyzed as independent samples. Univariate analysis of the two groups of variables showed that, except for nodule location, the differences in the remaining variables were statistically significant (P<0.05). Multivariate logistic regression analysis showed that age, nodule type (subsolid pulmonary nodule), average density, spicule sign, and vascular convergence sign were independent influencing factors for non-benign pulmonary nodules, among which age, nodule type (subsolid pulmonary nodule), spicule sign, and vascular convergence sign were positively correlated with non-benign pulmonary nodules, while average density was negatively correlated with the occurrence of non-benign pulmonary nodules. The area under the receiver operating characteristic curve (AUC) of the malignancy risk value given by the AI system in predicting non-benign pulmonary nodules was 0.811, slightly lower than the 0.898 predicted by clinicians. In the PGL/MIA/IAC analysis, clinical data from a total of 411 patients with pulmonary nodules were included, of which there were 149 males (8 patients of double primary lesions) and 262 females (17 patients of double primary lesions), with a median age of 56.0 (50.0, 61.0) years. Different lesions in the same patient were analyzed as independent samples. Univariate analysis results showed that, except for gender, nodule location, and vascular convergence sign, the differences in the remaining variables among the three groups of PGL, MIA, and IAC patients were statistically significant (P<0.05). Multinomial multivariate logistic regression analysis showed that the differences between the parameters in the PGL group and the MIA group were not statistically significant (P>0.05), and the maximum diameter and average density of the nodules were statistically different between the PGL and IAC groups (P<0.05), and were positively correlated with the occurrence of IAC as independent risk factors. The average AUC value, accuracy, recall rate, and F1 score of the AI system in predicting lung nodule pathological type were 0.807, 74.3%, 73.2%, and 68.5%, respectively, all better than the clinical physicians’ prediction of lung nodule pathological type indicators (0.782, 70.9%, 66.2%, and 63.7% respectively). The AUC value of the AI system in predicting IAC was 0.853, and the sensitivity, specificity, and optimal cutoff value were 0.643, 0.943, and 50.0%, respectively. Conclusion This AI system has demonstrated high clinical value in predicting the benign and malignant nature and pathological type of lung nodules, especially in predicting lung nodule pathological type, its ability has surpassed that of clinical physicians. With the optimization of algorithms and the adequate integration of multimodal data, it can better assist clinical physicians in formulating individualized diagnostic and treatment plans for patients with lung nodules.

Objectives:To investigate the association between social determinants of health(SDOH)and incident stroke and analyze the main risk factors for stroke among resident with different SDOH levels. Methods:From 2012 to 2015,30 036 residents(≥35 years old)from 30 districts in 14 provincial-level administrative divisions in China were enrolled this study based on stratified multi-stage-random-sampling method.The prevalence of cardiovascular diseases and related risk factors were investigated,and stroke events were followed up in 2018 to 2019.Principal component analysis was performed to establish SDOH scores based on 9 indicators related to socioeconomic and healthcare resources,participants were divided into low SDOH group(n=8 343)when it was≥-2.01 to<-1.14,middle SDOH group(n=7 257)when it was≥-1.14 to<0.10,and high SDOH group(n=8 457)when it was≥0.10 to≤5.79.Multivariate Cox regression was applied to estimate the association of SDOH levels with incident stroke.The random survival forest method was used to analyze the major risk factors in different SDOH levels. Results:A total of 24 057 participants were finally included,669(2.8%)participants developed stroke during a mean of(4.7±0.8)years follow-up.The incidence densities of stroke in the low,medium,and high SDOH groups were 468.39,628.85,and 700.39/100 000 person-years,respectively(Pdifference<0.05,Ptrend=0.01).Compared with individuals with low SDOH level group,fully HR for incident stroke among those with medium and high were 1.91(95%CI:1.54-2.36)and 1.59(95%CI:1.30-1.95),respectively(Ptrend<0.001).Advanced age is the primary risk factor for stroke in the population,especially in districts with high SDOH level.In districts with medium SDOH level,diabetes is an important risk factor for stroke.High blood pressure and alcohol consumption are important modifiable risk factors in low SDOH level districts. Conclusions:Present study shows that higher levels of SDOH are associated with increased risk of stroke.The main risk factors for stroke differ among participants with different SDOH level districts.Targeted interventions should be implemented to improve the prevention and treatment of stroke in populations with different levels of SDOH.

Pre-rheumatoid arthritis （Pre-RA） is the asymptomatic state of rheumatoid arthritis （RA）， and its progression showed complexity， dynamics and significant individual differences. The dynamic prediction model is valuable in identifying individual risks and taking timely preventive and control measures. It is believed that applying the dynamic prediction model to traditional Chinese medicine （TCM） clinical studies of Pre-RA is expected to predict the critical state of Pre-RA to RA， reveal the evolution of Pre-RA， reflect the external authenticity of the TCM clinical studies， and complement the clinical efficacy evaluation method. Accordingly， it is envisioned to construct a dynamic prediction model for Pre-RA progression based on TCM clinical trial data through the dynamic prediction model algorithm， and to apply long-term follow-up cohort data for external validation， thereby providing a basis for scientific warning and clinical decision-making on the evolution of Pre-RA.

Model informed precision dosing for warfarin is to provide individualized dosing by integrating information related to patient characteristics, disease status and pharmacokinetics /pharmacodynamics of warfarin, through mathematical modeling and simulation techniques based on the quantitative pharmacology. Compared with empirical dosing, it can improve the safety, effectiveness, economy, and adherence of pharmacotherapy of warfarin. This consensus report describes the commonly used modeling and simulation techniques for warfarin, their application in developing and adjusting dosing regimens, medication adherence and economy. Moreover, this consensus also elaborates the detailed procedures for the implementation in the warfarin pharmacy service pathway to facilitate the development and application of model informed precision dosing for warfarin.

Background:In the clinical setting, the effect of intra-abdominal hypertension on the human body is dependent on time, but its role is not yet clear.Objective:To investigate the effect of the duration of intra-abdominal hypertension (IAH) on the prognosis of critically ill patients.Methods:This prospective cohort study enrolled 256 IAH patients who were admitted to the Surgical ICU of 10 Grade A hospitals in Fujian Province from January 2018 to December 2020. The duration of IAH (DIAH) was obtained after monitoring IAP, and ICU length of stay, duration of mechanical ventilation, duration of continuous renal replacement therapy (CRRT) and average daily energy intake from enteral nutrition during ICU stay were observed and recorded. The correlation was analyzed by Spearman rank correlation. The patients were divided into the survival group and the death group according to their survival state at 60 days after enrollment. Thereafter, clinical characteristics between the two groups were compared. Multivariable logistic regression was used to study and validate the relationship between DIAH and 60-day mortality. The receiver operating characteristics (ROC) curve was established to evaluate the predictive abilities of DIAH on the mortality risk.Results:In critically ill patients, DIAH was positively correlated with duration of mechanical ventilation ( r=0.679, P<0.001), duration of CRRT ( r=0.541, P<0.001) and ICU length of stay ( r=0.794, P<0.001), respectively. In addition, there was a negative correlation between DIAH and average daily energy intake from enteral nutrition ( r=-0.669, P<0.001). After multivariable adjustment, DIAH was an independent risk factor for 60-day mortality in critically patients with IAH ( OR=1.05, 95% CI: 1.01-1.12; P = 0.012), and exhibited a linearity change trend relationship with mortality risk. The ROC curve analysis of DIAH showed that the area under ROC curve (AUC) was 0.825 (95% CI: 0.763~0.886, P<0.01). When the cut-off value was 16.5 days, the sensitivity was 78.4% and the specificity was 75.4%. Conclusions:DIAH is an important risk factor for prognosis in critically ill patients. Early identification and rapid intervention for the etiology of IAH should be performed to shorten DIAH.

Postnatal heart maturation is the basis of normal cardiac function and provides critical insights into heart repair and regenerative medicine. While static snapshots of the maturing heart have provided much insight into its molecular signatures, few key events during postnatal cardiomyocyte maturation have been uncovered. Here, we report that cardiomyocytes (CMs) experience epigenetic and transcriptional decline of cardiac gene expression immediately after birth, leading to a transition state of CMs at postnatal day 7 (P7) that was essential for CM subtype specification during heart maturation. Large-scale single-cell analysis and genetic lineage tracing confirm the presence of transition state CMs at P7 bridging immature state and mature states. Silencing of key transcription factor JUN in P1-hearts significantly repressed CM transition, resulting in perturbed CM subtype proportions and reduced cardiac function in mature hearts. In addition, transplantation of P7-CMs into infarcted hearts exhibited cardiac repair potential superior to P1-CMs. Collectively, our data uncover CM state transition as a key event in postnatal heart maturation, which not only provides insights into molecular foundations of heart maturation, but also opens an avenue for manipulation of cardiomyocyte fate in disease and regenerative medicine.
Gene Expression Regulation ; Heart ; Myocytes, Cardiac/metabolism* ; Single-Cell Analysis ; Transcription Factors/metabolism*

Objective:To investigate the clinical effect of myocutaneous flap combined with antibiotic-loaded polymethylmethacrylate (PMMA) cement in the treatment of Cierny-Mader type III-IV osteomyelitis.Methods:From April, 2014 to March, 2019, 53 patients with Cierny-Mader type III-IV chronic osteomyelitis were treated with myocutaneous flap combined with antibiotic-loaded PMMA cement. There were 33 males and 20 females, with an average age of (52.2±3.0) (29-78) years old. The area of the wound ranged from 2.0 cm×2.0 cm to 14.0 cm×28.0 cm. All flaps were closed directly. There were 23 patients who were removed the cement at 3 months after surgery, and the other 30 were not. After the surgery, the blood supply of the flap, the effusion of the wound, the complications of the donor area, signs of fresh bone destruction on X-ray and the color, the texture and scar of the flap were observed in the follow-up at the clinic.Results:Forty-nine cases healed in one stage, and 4 had delayed healing. Postoperative vascular crisis occurred in 6 cases and releasesd by prompt surgical exploration. The patients were followed-up for 0.6-3.0 years, with an average of 18 months. All 53 myocutaneous flaps completely survived ultimately. The color of flaps was similar to the recipient areas, and the flaps were smooth and soft and satisfactory in appearance. During the follow-up period, X-ray examination showed no sign of fresh bone destruction. Osteomyelitis was significantly controlled. There was no inflammation reaction such as swelling, pain, ulceration and effusion of the flaps, and there was no recurrence of osteomyelitis. All donor areas healed primarily.Conclusion:Myocutaneous flap combined with antibiotic-loaded PMMA cement has achieved good anti-infection effects in satisfactory results, less postoperative complications and low recurrence rate in the treatment of Cierny-Mader type III-IV osteomyelitis. Application and promotion of such technique would deliver good benefits.

Objective To evaluate the feasibility and efficacy of laparoscopic liver resection (LLR) in elderly patients with hepatocellular carcinoma (HCC). Methods Twenty-nine elderly patients undergoing laparoscopic liver resection (LLR) and 58 elderly patients receiving open liver resection (OLR) for HCC were included from January 2013 to December 2015 in our department of Fujian Medical University. Two groups were 1:2 matched for gender ,tumor numbers ,and operative procedure.Besides ,general clinical data ,intraoperative data ,postoperative recovery ,and postoperative survival were compared. Results The postoperative hospital stay was shorter in the LLR group [(9.1±3.8)days]thanintheOLRgroup[(11.8±5.1)days](t= -2.66,P<0.05).Theincidence of portal triad clamping was lower in the LLR group than in the OLR group (34.5％ vs.60.3％ ,χ2 =5.18 ,P<0.05). The removal time of abdominal drainage tube was earlier in the LLR group (4.18 ± 1.94)days than in the OLR group (5.4 ± 2.1)days (t= -2.48 ,P<0.05). The overall survival (OS) showed no difference (37.08 months vs.38.72 months ,t=0.72 ,P=0.789). The disease-free survival (DFS) showed no difference (29.00 months vs.27.49 months ,t=0.53 ,P=0.467). Conclusions LLR in elderly patients with HCC can achieve the same long-term outcome as the conventional open hepatectomy ,and LLR has better short-term outcomes with obvious advantages of minimal invasion.

To investigate the effect of crocin on the progression and generalized seizure of temporal lobe epilepsy in mice.Hippocampus rapid kindling model was established in C57BL/6J mice. The effects of crocin on seizure stage, afterdischarge duration (ADD), number of stimulation in each stage and final state, the incidence of generalized seizure (GS), average seizure stage and ADD were observed.Crocin (20 mg/kg) significantly retarded behavioral seizure stages (<0.05) and shortened cumulative ADD (<0.01) during hippocampus rapid kindling acquisition in mice compared with vehicle group. Meanwhile, number of stimulations in stage 1-2 was significantly increased (<0.05) and the incidence of fully kindled animals was significantly decreased (<0.01). However, 10 or 50 mg/kg crocin showed no significant effect on the above indexes (all>0.05). Crocin (100 or 200 mg/kg) significantly decreased the incidence of GS (all<0.01) and reduced average seizure stages (all<0.01) in fully-kindled mice compared with vehicle group; Fifty mg/kg crocin only reduced average seizure stages (<0.05).Low-dose crocin can retard the progression in hippocampus rapid kindling acquisition in mice, while high-dose crocin relieves the GS in fully-kindled mice, which suggests that crocin may be a potential anti-epileptic compound.
Animals ; Anticonvulsants ; pharmacology ; Carotenoids ; pharmacology ; therapeutic use ; Dose-Response Relationship, Drug ; Electric Stimulation ; Epilepsy, Temporal Lobe ; chemically induced ; drug therapy ; Hippocampus ; drug effects ; physiopathology ; Kindling, Neurologic ; drug effects ; physiology ; Mice ; Mice, Inbred C57BL ; Seizures ; classification ; drug therapy

Objective To simulate the possible systematic delivery errors introduced by monitor units ( MU) and multi-leaf collimator ( MLC) in radiotherapy plans for nasopharyngeal carcinoma ( NPC) , and to analyze the dosimetric sensitivity of static intensity-modulated radiotherapy ( IMRT ) and volumetric modulated arc therapy ( VMAT) with these errors. Methods Five IMRT plans were replanned using VMAT modality with the same physical parameters, and then MU errors of 125%, 250%, and 5. 00% were introduced into IMRT and VMAT plans. Meanwhile, to simulate leaf position errors during delivery, MLC position errors (025 mm, 050 mm, 100 mm, 150 mm, and 200 mm) were introduced by modifying the original plan documents. The types of MLC errors were as follows:( 1) the MLC banks moved in the same direction;( 2) the MLC banks moved in opposing directions ( expand or contract the MLC gaps ) . The differences in dosimetric sensitivity introduced by MU and MLC errors between IMRT and VMAT plans for NPC were calculated by linear regression analysis. Results With the increase in MU errors, the doses to target and organs at risk ( OARs) of IMRT and VMAT plans increased in a linear way, and met R2=0992-1000( P<005) . For MLC errors, the average dosimetric sensitivity for target and OARs of IMRT and VMAT were-026%/mm and-065%/mm in case of offset errors, 487%/mm and 868%/mm in case of expansion errors, and -604%/mm and -988%/mm in case of indentation errors. In addition, the dosimetric sensitivity with the three types of MLC errors was greater for VMAT plan than for IMRT plan. ConclusionsMU and MLC errors have a significant effect on the dose distribution of IMRT, and particularly VMAT, for NPC. It is important to execute routine quality assurance of MLC to ensure accurate radiotherapy.